Provider Demographics
NPI:1639416555
Name:SALBATO, STEPHANIE L (PNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:SALBATO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:332 S ORCHARD SPRINGS DR
Mailing Address - Street 2:150
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6151
Mailing Address - Country:US
Mailing Address - Phone:719-253-7640
Mailing Address - Fax:719-253-7644
Practice Address - Street 1:332 S ORCHARD SPRINGS DR
Practice Address - Street 2:SUITE 150
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-6151
Practice Address - Country:US
Practice Address - Phone:719-253-7640
Practice Address - Fax:719-253-7644
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990547363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00204064Medicaid